In this article recently published in Neurology, Gutiérrez-Ortiz et al., report two patients infected with SARS-CoV-2 who presented with Miller Fisher syndrome and polyneuritis cranialis, respectively. The first patient was a 50-year-old man who presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation and positive testing for GD1b-IgG antibodies. The second patient was a 39-year-old man who presented with ageusia, bilateral abducens palsy, areflexia and albuminocytologic dissociation. Both patients developed fever variably associated with cough, headache, low back pain or diarrhoea, 3 to 5 days before the onset of neurological symptoms. Oropharyngeal swabs for COVID-19 by qrRT-PCR assay was positive in both patients and negative in the cerebrospinal fluid. The first patient was treated with intravenous immunoglobulins and the second with acetaminophen. The authors reported good clinical outcome in both cases. In the discussion, the authors considered the possible pathogenic mechanisms of Miller Fisher syndrome and polyneuritis cranialis in COVID-19 infection, hypothesise an aberrant immune response and discuss possible therapeutic implications.
by Marialuisa Zedde and Francesco Cavallieri